| NPI | 1306230008 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANN JEAN HACKBARTH A RN P 712-338-6911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: IA G-092068) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2015-03-20 |